Unknown Individual – Otolaryngology Physician, NPI 1629022348

Unknown Individual is a healthcare provider. based in Marshall, Michigan. specializing in Otolaryngology Physician. They hold a License No. MG087034 (MI). The NPI Number for Unknown Individual is 1629022348

Main info

Organization
Inactive
43 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1629022348
Phone
(269) 789-0015
Address
215 E MANSION ST
Deactivation Date
24 April 2025

Doctor Profile

Medical School Name
JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
5179241605
Graduation Year
1983 (43 years ago)
PAC ID
5294749446
Group Practice PAC ID
1254228745
Professional Enrollment ID
I20060126001022
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 215, East Mansion Street, Marshall, Calhoun County, Michigan, 49068, United States

    SUITE 2D

    MARSHALL, MI 490681167

    Phone: (269) 789-0015

    Fax: (269) 789-1551

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 49068)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1254228745View full group profile
NameSpecialtyState
Nurse PractitionerMI
Family PracticeMI
G A S T R O E N T E R O L O G YMI
-MI
General SurgeryMI
Nurse PractitionerMI
Nurse PractitionerMI
Physician AssistantMI
-MI
-MI

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1629022348 — is the standard way to identify this listing.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Otolaryngology Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Marshall, Michigan may find Unknown Individual in results; validate coverage separately.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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